FAQs for Both Eligible Professionals and Eligible Hospitals

What does "Medicaid Patient Volume" mean?

  • Provider Type: Both
  • Category: Medicaid Patient Volume

For facilities, Medicaid patient volume is the ratio of acute care Medicaid patient encounters relative to the overall number of acute care patient encounters. The Medicaid patient volume is calculated over a 90-day period selected by the facility in the prior calendar year.

What is a "patient encounter"?

  • Provider Type: Both
  • Category: Medicaid Patient Volume

For the purposes of this program, a patient encounter means one or more services rendered to an individual on a given day. Multiple services on a single day constitute a single encounter.

What is a "Medicaid patient encounter"?

  • Provider Type: Both
  • Category: Medicaid Patient Volume

If Medicare was the primary payer for the hospital incentive, Medicaid patient encounters are any patient encounters for which Medicaid paid all or part of the cost of the service, including co-pays and managed care premiums, so long as Medicare was not the primary payer. If Medicaid was the primary payor, those encounters would be counted towards the Medicare EHR Incentive and may not be counted towards the Medicaid EHR Incentive.

How does participating in the Medicare EHR Incentive Program affect my ability to receive the Medicaid EHR Incentive?

  • Provider Type: Both
  • Category: General Program Information

Hospitals may participate in both the Medicare and Medicaid EHR Incentive Programs, in contrast to Eligible Professionals who must select one or the other of the programs. The Medicare program does not provide incentives for adoption, implementation, or upgrade of certified EHR technology in the first program participation year, participants must demonstrate meaningful use in the first year. In both programs, the first year of meaningful use is based on a 90-day reporting period within the payment year, and subsequent years of meaningful use are based on a full-year reporting period.

Dual-eligible hospitals who participate in both programs in a single year may not necessarily be in the same participation year in each program. For example:

  • A hospital may choose to apply only to Medicaid in the first year if it is not ready to demonstrate meaningful use, and then apply to both programs in the following year. At that point, the hospital will be in the first year of the Medicare program and the second year of the Medicaid program, which is the first year of meaningful use for both programs. The hospital could attest to meaningful use in both programs after a 90-day reporting period.
  • A hospital that is ready to demonstrate meaningful use now may apply to both programs in the first year attesting to Meaningful use in the Medicare program and AIU in the Medicaid program. The following year, the hospital would then be in its second year of meaningful use for Medicare but only the first year of meaningful use for Medicaid. The hospital could receive the Medicaid incentive payment after completing the 90-day reporting period, but would need to complete the full-year reporting period before receiving the Medicare incentive.

A hospital that successfully demonstrates meaningful use in the Medicare incentive program for a given year is deemed to be a meaningful user for the Medicaid program for that participation year. It is not necessary for a hospital to attest to meaningful use separately to both Medicare and Medicaid, although in some timing scenarios it may be beneficial to the hospital to do so.

Where can I get more information about the Medicaid EHR Incentive Program?

  • Provider Type: Both
  • Category: Other Information

The New York State Medicaid HIT Plan (NY-SMHP) can be found on the DOH website at the following address: http://nyhealth.gov/regulations/arra/docs/medicaid_health_information_technology_plan.pdf (PDF, 11.7MB, 410pg.)

Additional information on the program can be found at the CMS website for the Medicare and Medicaid EHR Incentive Programs http://www.cms.gov/ehrincentiveprograms/">

Information on meaningful use can be found on the website of the Office of the National Coordinator for Health IT healthit_hhs_gov__meaningful_use_announcement/2996

In the first year, do providers need to show Adoption, Implementation, or Upgrade (AIU) of a certified EHR technology or do they need to meet the Eligibility Criteria and Medicaid Patient Volume and then show AIU?

  • Provider Type: Both
  • Category: Medicaid Patient Volume/AIU ONC Certified EHR Technology

Once a provider has demonstrated that he or she has met all the eligibility criteria to participate in the Medicaid EHR Incentive Program (including minimum Medicaid patient volume as described above, as well as other criteria such as provider type and hospital-based status), the provider will need to attest to the following:

  1. 1) In the first year the Eligible Provider must attest to having adopted, implemented, or upgraded certified EHR technology. This certification is conducted by various organizations according to a procedure established by the Office of the National Coordinator for HIT (ONC). Note that these organizations certify complete EHR systems as well as EHR modules which meet some, but not all, of the certification criteria. In order to meet the AIU requirement, the EP must have a complete system or a combination of modules that together form a complete system. For a list of products that have been certified or to verify that your product is certified, please consult ONC's Certified Health IT Product List (CHPL) at http://onc-chpl.force.com/ehrcert.
  2. 2) In their second and subsequent years of participation, EPs must demonstrate that they are "meaningful users" of the certified EHR technology. In order to do this, they will need to attest to meeting a number of meaningful use objectives, which become more rigorous over the course of the six-year incentive program.

Only after demonstrating both eligibility and either AIU or Meaningful Use (depending on the participation year) will an EP be deemed eligible to receive the incentive payment. The process by which an EP applies for the incentive payment begins by registering at the federal level for the Medicare or Medicaid EHR Incentive Programs. The EP then attests to eligibility and AIU or Meaningful Use through a New York system.